Jobs, pay at root of rural Ohio’s opioid crisis?

Despair caused by a lack of jobs and hope is the greatest single factor in the growing opioid addition crisis in rural Ohio.

This despair, according to two Ohio State University experts who shared their data and views at last Thursday’s closing forum at the Farm Science Review near London, results from low wages and a failure to obtain the “American Dream” which ultimately leads to opioid addiction.

In their presentation called “Despair in Rural America — Opioid Problem or Symptom,” Mark Partridge, SWANK Chair in Rural-Urban policy at Ohio State University; and Mike Betz, Assistant Professor in the Department of Human Sciences at Ohio State, not only pointed to the fact that the issue of drug overdoses is prevalent in rural Ohio, but provided data to explain why this addiction is such a crisis in our small towns and rural communities.

Moderator Chris Bruynis, Ross County Extension Educator, pointed out the severity of the opioid problem in Ohio and asked the two professors what the causes of this addiction were and what can be done to reverse the trend.

There were 3,050 overdose deaths in Ohio in 2015, with 58.2 percent of the deaths blamed on the use of fentanyl and its derivatives, an opioid 50 times stronger than heroin.

“Why are people demanding opioids at a higher rate?” Betz wondered, and pointed out that jobs play an important role in peoples’ lives.

Rural connections

“There’s been some good research on this recently that shows how this affects opioid overdose death rates. Researchers have found that looking at unemployment rates in counties — for a 1 percent increase in the unemployment rate, the overdose death rate increases 3.6 percent. So you think about a county with a five-year jobless rate change of 3 percent, which during the Great Recession isn’t out of the realm of possibilities, that could increase the overdose death rate by 10 percent,” he said.

“There is a connection here,” Betz said. “There is more and more evidence that employment is an important factor in the overdose problem.”

At the same time, it’s not just jobs but the type of jobs you have. “Maybe the employment rate in a rural county has remained stable, but what type of jobs are they? Good jobs, manufacturing jobs that were making $25 an hour? A lot of those have gone away and have been replaced by retail jobs that are earning $12 an hour,” he said.

“Very preliminary work that myself and a couple of co-authors have done, we looked at how wages affect this, and we found that for a 1 percent decrease in wages, you see a 3.5 percent increase in overdose death rates. This number is even higher for rural whites — it is about 4.5 percent. So for rural whites if there is a 3 percent decline in wages in the county, these could be almost a 15 percent increase in drug overdoses,” Betz said.

The result, Partridge said, is what’s called “Depths of Despair” and a recent study has shown particularly among white middle age males that life expectancy is falling, “maybe for the first time ever in American history.”

“I asked my research assistant to get some data on Appalachian Ohio. Let’s just compare it to metropolitan Ohio,” Partridge said.

“Since 1980, in Appalachian Ohio there has been literally zero job growth, while in metropolitan Columbus there has been 75 percent job growth,” he pointed out.

“Likewise in terms of wage growth, it is more than twice as fast in metropolitan Columbus as in Appalachian Ohio. And Appalachian Ohio already was quite poor. The point is, this has especially hit my generation, where I am going to be 55. Coming out of high school in 1981 there was just a real difference in the type and stability of jobs.”

Betz pointed out that the supply of prescription drugs has quadrupled since 1999. “This is a huge increase in the availability of opioid drugs,” he said.

Why the demand?

At the same time it’s not just a supply side problem. While those drug rates are increasing there is an increase in the suicide rate as well. “This points to a bigger picture that it is not just the availability of drugs — there is something else going on that is also causing people to use these drugs,” Betz said.

“We call those demand side factors. Why are people demanding more drugs? When you look at the disparity between urban and rural suicide rates — rural suicide rates are about twice that of urban suicide rates for both males and females. That is a striking contrast that rural young people are killing themselves at twice the rate than in urban areas.”

In addressing these problems, one of the biggest ways that policy makers have addressed the supply side has been to come up with drug monitoring programs, so there is a database tracking each prescription, Betz pointed out. “Research has found that where doctors are forced to access these data bases that reduces the number of overdoses in the county and state. Fortunately Ohio is a ‘must access’ state.”

Betz said as a result, what they have seen since 2012 is a sharp decline in Ohio in the number of prescriptions.

But the absolute magnitude in the number of doses being prescribed is staggering, he added. “Even after the 20 percent decline between 2012 and 2016, there are still 635 million doses prescribed in Ohio alone. That’s 54 doses for every citizen in Ohio,” he said.

“These are shocking numbers, and you should be shocked by them.”

He said even with the 20 percent reduction in prescriptions, the overdose rate has actually increased faster, at a faster rate than leading up to that. He said this likely is because people shifted from using controlled substances like Oxycontin and things like that which were prescribed and manufactured by pharmaceutical companies in a controlled environment to street drugs, because the prescription drugs were no longer available.

One surprising bit of data shared by Betz is that even though there has been a four-fold increase in opioids, the amount of pain that Americans report hasn’t decreased at all. “We are medicating ourselves more and more but how we report pain hasn’t changed at all. It’s not improving lives significantly,” he said.

Jobs and wages

Lastly, he said, there needs to be ways to bolster labor markets, not only in the short term but in the long term, including education. “This problem is more concentrated in lower-educated populations,” he said.

“Just going from a high school degree to some college reduces your overdose rate by four and half times. If you get a bachelor’s degree, it is 14 times less than those who only have a high school degree,” he pointed out.

In 1980, the wage difference between a high school degree and college degree was only about 20 percent. “Today, that gap is about 75 percent. So you have a huge divergence between the people who have education versus people who don’t.

Another economic factor in the increase in opioid abuse in rural communities is household income.

”Living standards: since 1973, median household income has barely budged in the United States,” said Partridge. “In particular, the group that has really suffered in terms of lack of growth has been white men. They have not seen an increase after adjusting for inflation since 1972.”

He said that where it matters regarding the opioid crisis is that if you have expectations such as “I will have things like my parents,” and then these aspirations are completely dashed, “and it creates a lot of problems. Since 1972, instead of seeing what we had seen in the past with wages, a four-fold increase, wages were flat. You can see with Americans putting so much value in their life in their jobs, one can easily identify that if they are not doing well in the labor market then they feel they are a failure,” he said, leading to drug abuse.

“Hence the need for treatment to focus on other areas of their lives,” Partridge added.